Sr. Investigator

Sr. Investigator, Remote

• Contract to Hire
• Remote 
• U.S. citizen or authorized to work in the U.S., with at least three years of verifiable U.S. residency in the last five years.
• Ability to obtain and maintain a Public Trust Government Clearance.
• NO THIRD PARTY RECRUITERS.

We are seeking a Sr. Investigator for our client to examine and assess healthcare providers’ compliance related to healthcare legislation. This position conducts research and analysis, pulls information, cites regulations using regulatory language, reviews provider documents, and generates complete written outcome reports of enforcement investigations a provider’s compliance with the law. This opportunity is especially attractive to someone who likes to research legal and regulatory requirements and has an analytical mind. 

Responsibilities

•           Conducts and oversees comprehensive investigations into potential violations to determine provider compliance with contractual obligations and regulatory requirements.
•       Drafts and reviews detailed, substantive investigative reports, complaint summaries, and findings documents for internal and client use.
•       Performs in-depth analysis of provider operations and documentation to identify trends, compliance gaps, and process inefficiencies.
•       Leads the development, review, and maintenance of project artifacts—including User Guides, Standard Operating Procedures (SOPs), workflows, and templates—based on evolving project and client requirements.
•       Mentors and supports junior investigators, providing guidance on best practices in investigative techniques, documentation, and client communication.
•       Identifies and implements process improvements to enhance team efficiency, accuracy, and overall project performance.
•       Facilitates and leads virtual meetings with providers and stakeholders to present findings, clarify documentation requests, and support compliance initiatives.
•       Collaborates with cross-functional teams, project leadership, and external agencies to ensure consistent application of compliance standards and regulatory interpretations.
•       Maintains clear, organized, and detailed records of investigative actions, findings, and follow-up efforts to ensure transparency and audit readiness.

Qualifications

•           Minimum of four (4) years post-education work experience in a corporate environment with at least 3 of those years performing investigations directly; Master’s degree in a business or applicable technical field to substitute for 2 years’ experience.
•       Bachelor’s degree in public policy, public health, health administration, business, or a related field, from an accredited college/university.
•       Possess a working knowledge of compliance laws, regulations, and healthcare industry practices.
•       Possess a working knowledge of health insurance cost sharing requirements for Medicare, Medicaid, and private insurance and/or the ability to quickly learn complex information and apply the information to conducting investigations.
•       Detail-oriented and strong writing skills.
•       Self-directed and deadline-driven.
•       Flexible and proactive team player.

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